Talat Islam, MBBS, Ph.D., is an environmental epidemiologist with a strong track record in studying the effect of genes and environment on respiratory health outcomes in children. The purpose of this K01 IRSDA application is for Dr. Islam to build on his background and extend his expertise to conduct international research in maternal and child health through training in exposure assessment, and reproductive and perinatal epidemiology. The scientific aims of this proposal are based on the findings that exposure to biomass fuel smoke from traditional cook stoves can lead to adverse pregnancy outcomes and acute lower respiratory tract infection (ALRI) in children. Adverse pregnancy outcomes and ALRI are major threats to maternal and child health in Bangladesh. The prevalence of low birth weight (LBW-53%), small-for-gestational age (SGA-70%) and pre-term birth (<37 weeks-22.5%) is high in Bangladesh. One in every 19 children born in Bangladesh dies before their 1stbirthday and ALRI accounts for more than 50% of the infant mortality. Environmental exposures including air pollution from cook stoves and arsenic (As) from drinking water can contribute to these adverse outcomes. The prevalence of biomass fuel (BMF) used for cooking is 88%, and exposure to >10?gm/l As in drinking water is common (33%) in Bangladesh. Therefore, the major aim of this proposal is to investigate the effect of maternal exposure to biomass combustion products on pregnancy outcomes and ALRI incidence during the first 6 months of life in Bangladesh. We also propose to explore the joint effect of biomass combustion exposure and As exposure on those outcomes. A key innovation is the development of an exposure model for black carbon (BC), product of incomplete combustion of BMF, using cost-effective novel monitors suitable for large epidemiological studies in LMIC settings. We will also measure Hb-DNA adducts of polycyclic aromatic hydrocarbons (PAH) in the cord blood of a sub-population of new-born as a biologically effective dose for exposure to PAHs and investigate its possible link to study health outcomes and maternal exposure to BMF. Successful completion of these aims builds on the expertise of the candidate and extends it to exposure assessment and reproductive and perinatal epidemiology in a global research setting that requires additional training and mentorship. The candidate will attain the necessary expertise by working with experts in the relevant fields, through formal course work, structured mentored training and laboratory work. [This project will take advantage of the available infrastructure in Bangladesh through the highly respected LMIC research institution, International Center for Diarrhoeal Disease Research, Bangladesh (ICDDR,B) that will enable the candidate to establish a pregnancy cohort of 900 women and follow the newborns for six month at a cost effective efficient manner.] This grant, beyond providing the necessary training to the candidate to be established as an independent international researcher, will address important gaps in evidence on the effects of cook stove exposure on maternal and child health, and will provide a resource for future studies.